Industry Affiliate Program Logo

2012 Application Form

Industry Affiliate Program Logo

  • To join IAP for calendar year 2012, please fill out the form below, submit your registration, and then select “Pay by Credit Card” or “Pay by Check”.
  • For a description of Standard Member and Gold Member benefits, please visit the main IAP web page.
  • Membership in ITRC’s Industry Affiliates Program (IAP) is per calendar year. IAP membership by companies and trade associations is required prior to employees joining ITRC technical teams.
  • If you have questions about IAP registration or payment, please contact Carolyn Sistare, 202-266-4932, csistare@ecos.org.

Note: * Indicates a required field.

* Please select your company type:
Industry
Trade Association - An organization that represents the interests of the member firms of an industry.
* Please select your membership type: (Please select your Company Type first)
Industry:
Trade Association:
Was your company a 2011 ITRC Industry Recognition Award Winner? (View 2011 Award Winners)
If yes, click to apply your discount.
 
* First Name:
* Last Name:
* Title:
* Company Name:
* Company Address:
* City:
* Please select the state or enter the province
State:
  OR  
Province:
* Country:
* Zip Code:
Please enter your phone and/or fax numbers in the following format: 434-234-2688
* Phone Number:
Fax Number:
* E-mail:
Company Website URL:
How did you learn about IAP?: Current Member
Conference
Website
Training
Other

Please describe.
CAPTCHA Image
(I can't read it)
captcha
Please carefully enter the 8 characters in the image above.